CAJ | 학술논문

目的：探讨间充质干细胞（Mesenchymal stromal cell，MSC）联合单倍体相合造血干细胞移植（haploidentical hematopoietic stem cell transplantation，Haplo-HSCT）治疗再生障碍性贫血接受HLA全相合移植后迟发排斥的效果。方法2例输血依赖再生障碍性贫血患者，分别于非血缘HSCT后2、3个月出现迟发排斥，接受Haplo-HSCT。预处理方案包括白消安、氟达拉滨和环磷酰胺。使用抗胸腺细胞球蛋白或抗CD52抗体进行体内清除T淋巴细胞。采用环孢素A、甲氨蝶呤、吗替麦考酚酯和抗CD25单克隆抗体，进行移植物抗宿主病预防。移植物为重组人粒细胞集落刺激因子动员的骨髓、外周血造血干细胞和脐带来源MSC。结果2例均出现快速造血植入，DNA指纹分析显示为供者嵌合，均未发生严重移植物抗宿主病。1例移植23个月后并发病毒性肺炎死亡；另1例随访21个月，处于无病生存状态。结论 Haplo-HSCT联合MSC输注，可作为再生障碍性贫血患者非血缘全相合移植后迟发排斥的挽救措施之一。
목적：탐토간충질간세포（Mesenchymal stromal cell，MSC）연합단배체상합조혈간세포이식（haploidentical hematopoietic stem cell transplantation，Haplo-HSCT）치료재생장애성빈혈접수HLA전상합이식후지발배척적효과。방법2례수혈의뢰재생장애성빈혈환자，분별우비혈연HSCT후2、3개월출현지발배척，접수Haplo-HSCT。예처리방안포괄백소안、불체랍빈화배린선알。사용항흉선세포구단백혹항CD52항체진행체내청제T림파세포。채용배포소A、갑안접령、마체맥고분지화항CD25단극륭항체，진행이식물항숙주병예방。이식물위중조인립세포집락자격인자동원적골수、외주혈조혈간세포화제대래원MSC。결과2례균출현쾌속조혈식입，DNA지문분석현시위공자감합，균미발생엄중이식물항숙주병。1례이식23개월후병발병독성폐염사망；령1례수방21개월，처우무병생존상태。결론 Haplo-HSCT연합MSC수주，가작위재생장애성빈혈환자비혈연전상합이식후지발배척적만구조시지일。
Objective This study was aimed to observe the effectiveness of co-infusion of mesenchymal stromal cell and hematopoietic stem cell in the treatment of the delayed rejection of HLA-matched transplant. Method Two cases of aplastic anemia who received HLA-matched unrelated HSCT were diagnosed as delayed graft rejection that occurred 2 and 3 months post transplantation respectively. The patients received a conditioning regimen consisting of busulfan, fludarabine and cyclophosphamide. Anti-thymocyte globulin or anti-CD52 antibody was used to deplete T lymphocytes in vivo. Graft-versus-host disease prophylaxis was conducted with cyclosporine A, methotrexate, mycophenolate mofetil, and anti-CD25 monoclonal antibody. The patients received grafts including G-CSF stimulated bone marrow, peripheral blood stem cell and umbilical cord mesenchymal stromal cell. Results Two patients had rapid hematopoietic engraftment, and DNA fingerprint analysis revealed complete donor chimera. No severe graft versus host disease was observed. One patient died of viral pneumonia 23 months post transplantation. One case is alive and has had a good health performance during the follow-up of 21 months. Conclusion The data here suggest that haplo-identical HSCT with umbilical cord mesenchymal stromal cell might provide an opportunity of salvage therapy for aplastic anemia with graft rejection after HLA-matched unrelated donor transplant.